Efficacy of Ultrasound Guided Single Level Paravertebral Block vs Transmuscular Quadratus Lumborum Block (III) for Postoperative Analgesia after Percutaneous Nephrolithotomy Surgeries- A Randomised Clinical Study

Abstract

Introduction: Pain control forms an essential component of enhanced recovery after surgery. Regional nerve blocks forms the mainstay of pain relief now-a-days. Pain after Percutaneous Nephrolithotomy (PCNL) surgeries is always distressing to the patient due to injury to the renal capsule. Aim: To compare the efficacy of Ultrasound (USG) guided Paravertebral Block (PVB) versus Quadratus Lumborum Block (QLB) for postoperative analgesia following PCNL surgeries. Materials and Methods: This randomised clinical study was done between February 2021 to August 2022 at Narayana Medical College and Hospitals, Nellore, Andhra Pradesh, India. Sixty patients of American Society of Anaesthesiology (ASA) I and II between 30-60 years age group undergoing PCNL surgeries were divided into two groups. Group P received USG guided PVB at T9-T10 level with 20 mL of 0.25% Levobupivacaine with 8 mg Dexamethasone whereas group Q received QLB (III) with 20 mL of 0.25% Levobupivacaine with 8 mg Dexamethasone. Visual Analogue Score (VAS), time for first rescue analgesic and number of patients requiring rescue analgesic in first 24 hours were measured. unpaired t-test was used to compare continuous variables whereas the Chi-square test was to compare the categorical variables. Results: There was no statistical difference in terms of sex, age, weight, height or ASA grade (p>0.05). The mean time required for rescue analgesia in group P was around 478 minutes compared to group Q with 346 minutes which was statistically significant (p=0.001). Mean tramadol consumption in group Q was significantly high (155 mg) compared to group P (125 mg). VAS was significantly better in group P. Conclusion: USG guided single level PVB provides superior analgesia compared to transmuscular QLB for postoperative analgesia after PCNL surgeries which helps in enhanced recovery after surgery.